Cancer In Young People Research Articles

Metastasis of gastric cancer in the femur in a 17-year-old patient (case report)

Primary gastric cancer is an extremely rare finding in young people. This applies to both children and adolescents [7, 9] and is true even for a sample of patients up to 40 years of age. According to McGill et al. [8], gastric cancer accounts for only 0.05% of malignant tumors of the gastrointestinal tract in children and adolescents. It is generally accepted that the manifestations of stomach cancer in young people practically do not differ from those in older age groups. Usually, developing gastric carcinoma proceeds under the guise of peptic ulcer and the correct diagnosis is made only in the later stages, which determines an extremely unfavorable prognosis for this disease. Histologically, gastric cancer in such patients is most often an undifferentiated adenogenic cancer with a diffuse-infiltrative type of growth.

CASE STUDY ON SMALL LUNG CELL CARCINOMA IN A 26-YEAR-OLD MALE

Introduction: A small-cell lung carcinoma is an aggressive form of lung cancer that is strongly associated with cigarette smoking and tends to early disseminate in the body. It represents about 20 per cent of all lung cancer. Increasing evidence has implicated autocrine growth loops, proto-oncogenes, and tumour-suppressor genes in its development as well as cigarette smoking, exposure to occupational carcinogens such as radon, asbestos, arsenic, crystalline silicon and benzopyrene e.t.c.
 Materials and Methods: This case study reports the management of suspected small lung cell cancer in a resource-limited centre diagnosed from transthoracic pleural biopsy in a 26-year-old male who had a history of cigarette smoking from preteen years (9 years). He was stabilized at the emergency with insertion of chest tube, antibiotics, analgesics and oxygen but couldn't commence treatment for lung cancer owing to the late diagnostic test done as a result of severe financial constraints and died three weeks post-hospital admission.
 Results: This case shows that early exposure to risk factors associated with lung cancer such as cigarette smoking, exposure to harmful chemicals in Plaster of Paris can lead to aggressive lung cancers like small cell lung cancer in young people.
 Recommendations: Increase public awareness of tobacco smoking in all age groups, adequate healthcare financing and insurance schemes and adequate funding for small cell lung cancer research to improve and promote prevention, early detection and proper treatment of the disease.

Bladder Cancer in Young Patients: Management and Outcomes

Background and Objective: Bladder cancer frequently occurs between the ages of 50 years and 70 years and rarely occurs before the age of 40 years. It accounts for 1% - 4% of all cases of cancer. This study focuses on the clinical, etiological, histological, therapeutic, and evolutive profiles of patients with bladder cancer aged less than 45 years. Materials and Methods: This retrospective study was carried out over seven years (from January 2014 to December 2020) on 15 patients below 45 years of age who were being treated for bladder cancer. The diagnosis was made in all patients via cystoscopy and abdominal computerized tomography, while the nature, grade, and degree of infiltration were determined via endoscopic resection and pathology. Results: The mean age of the 15 patients in this study was 34.4 ± 5.19 years. In 86.6% of cases, the patients had macroscopic hematuria as the main presenting complaint. Twelve patients (80%) had bladder tumors that did not infiltrate the muscle. These patients were followed up clinically. In 86.6% of cases, there was a single tumor with a mean diameter of 2.53 cm. In four patients (26.6%), mitomycin was started early. The overall rates of tumor recurrence and progression were 26.6% and 20%, respectively. Conclusion: Bladder cancer also occurs in young people, with similar clinical and epidemiological profiles as exists in elderly patients. The prognosis of bladder cancer in young people depends on the treatment method chosen by the physician.

KẾT QUẢ PHẪU THUẬT UNG THƯ TUYẾN GIÁP THỂ BIỆT HÓA Ở NGƯỜI TRẺ TUỔI

Introduction: Thyroid cancer in young people has distinguished features compared to the older, which affects surgical plan and outcome. Participants and Methods: This is a prospective cohort study of 89 well-differentiated thyroid carcinoma patients under 40 years old treated by surgery at Hanoi medical university Hospital from September 2019 to May 2020. Results: The proportions of patients who had undergone total thyroidectomy and lobectomy were 46.9% and 53.1%, in each group neck dissection had been performed in 92.7% and 25.6%% respectively. Recurrent laryngeal nerve injury and hypocalcemia were the two most common complications, accounting for 23,6% and 17,2% after 72h respectively, in which patients with total thyroidectomy had higher rates. Conclusion: Total thyroidectomy and lobectomy increased the risk of complications of recurrent laryngeal nerve damage and parathyroid gland damage. Complications were also more common among patients with lymph node dissection, but the difference was not statistically significant. Keywords: well-differentiated thyroid cancer, young people, surgical outcomes

Prediction of the Survival Outcomes of Patients with Non-Small Cell Cancer Using 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography and Clinicopathological Factors

Despite an overall decrease in the incidence of lung cancer, the incidence of the disease is increasing among young people. According to research, this upward trend is due to reduced consumption of vitamin D in foods such as fish, mushrooms, eggs and milk. There is growing evidence of a link between vitamin D and the risk of death from lung cancer, but there is little research on whether vitamin D intake is associated with a risk of lung cancer (before age 50). Because vitamin D deficiency has been on the rise over the past few years, we looked at whether it could increase the risk of lung cancer in young people. The results of this study show that taking 300 units of vitamin D a day or more, roughly equivalent to three glasses of milk, reduces the risk of lung cancer by about 50%. Previous studies have shown that taking more vitamin D is associated with a reduced risk of developing precancerous lung polyps before the age of 50. The findings are based on data from more than 94,000 women, part of a long-running study that began in 1989. They were 25 to 42 years old at the start of the study. It should be noted that the researchers did not find a significant association between vitamin D intake and the risk of lung cancer after age 50. Researchers say more research is needed to determine whether vitamin D actually provides more protection against lung cancer in young people. The researchers say the findings could lead to recommendations for getting more vitamin D as a low-cost supplement for screening tests to prevent lung cancer in adults under 50. Keywords: Cancer; Cells; Tissues; Tumors; Prevention; Prognosis; Diagnosis; Imaging; Screening; Treatment; Management

Diagnostic and treatment intervals are not associated with survival in rhabdomyosarcoma: A Cancer in Young People in Canada study.

Delay in diagnosis and treatment initiation can be associated with adverse outcomes in children with cancer. Diagnostic interval (DI) is defined as the time between the date of first health care contact for symptoms related to cancer to the date of cancer diagnosis, and treatment interval (TI) is defined as interval between the definitive cancer diagnosis and cancer treatment initiation. We aimed to determine the predictors of DI and TI in children with rhabdomyosarcoma (RMS) and their association with event-free survival (EFS) and overall survival (OS). Using the Cancer in Young People in Canada (CYP-C) national population-based database, we conducted a retrospective cohort study of children (0-14.99years) newly diagnosed with RMS between 2001 and 2015 in Canada. Quantile regression was used to assess the predictors of DI and TI, and Cox regression was used to determine if these intervals were associated with EFS and OS. Median DI and TI were 16.5days (interquartile range [IQR] 6.0-38.0) and 5days (IQR 0-12), respectively. DI and TI were not significantly associated with age at diagnosis, sex, race, tumor site, stage or histology, treatment region, distance from treatment center, income quintile or diagnosis year (all p>.05). DI and TI were not associated with EFS (DI: hazard ratio [HR] 1.00, 95% CI 0.96-1.05, p=.871; TI: HR 1.03, 95% CI 1.00-1.05, p=.053) or OS (DI: HR 0.99, 95% CI 0.94-1.05, p=.797; TI: HR 1.02, 95% CI 0.99-1.05, p=.155). In the publicly funded Canadian health care system, DI and TI did not affect the survival of children with RMS.

Reporting the whole story: Analysis of the 'out-of-scope' questions from the James Lind Alliance Teenage and Young Adult Cancer Priority Setting Partnership Survey.

ObjectiveWe conducted a UK‐wide survey to identify the top 10 research questions for young people's cancer. We conducted secondary analysis of questions submitted, which were ‘out‐of‐scope’ of the original survey aim. We sought to disseminate these questions, to inform practice, policy and the development of potential interventions to support young people with cancer.DesignJames Lind Alliance Priority Setting Partnership.ParticipantsYoung people aged 13‐24 with a current/previous cancer diagnosis, their families/friends/partners and professionals who work with this population.MethodsEight hundred and fifty‐five potential research questions were submitted, and 326 were classified as ‘out‐of‐scope’. These questions, along with 49 ‘free‐text’ comments, were analysed using thematic analysis.ResultsThe 375 out‐of‐scope questions and comments were submitted by: 68 young people, 81 family members/partners/friends and 42 professionals. Ten overarching themes were identified: diagnostic experience; communication; coordination of care; information needs and lack of information; service provision; long‐term effects and aftercare support; family support; financial impact; end‐of life care; and research methods and current research.ConclusionsThe need to tailor services, information and communication is a striking thread evidenced across the ‘out‐of‐scope’ questions. Gaps in information highlight implications for practice in revisiting information needs throughout the cancer trajectory. We must advocate for specialist care for young people and promote the research priorities and these findings to funding bodies, charities, young people and health and social care policymakers, in order to generate an evidence base to inform effective interventions across the cancer trajectory and improve outcomes.Patient/public contributionsPatients and carers were equal stakeholders throughout.

Editorial

In the UK (as I write this in early June) we are approaching 60% of the population having had at least one COVID-19 vaccine and almost 50% of all adults fully vaccinated. But there are still major issues with differential vaccination rates in various communities and the even greater problem of very limited rollout of vaccines across the world. Until we achieve high rates of international vaccination, we will not be able to consider ourselves in a postpandemic situation. For our profession, the effect of the pandemic has been, and continues to be, significant. The initial ruling that the vaccine could not be offered to pregnant (or even breastfeeding) women exemplified the lack of drug research in these vulnerable populations, which has, over the years, led to most medicines being prescribed off-licence. We now have a very confused pregnant population fearful of COVID-19 but, for many, more fearful of the vaccine. The impact of the pandemic on waiting lists in gynaecology has brought us back to a position we have not seen since the 1990s. We are in the fortunate position at TOG of having a large number of articles accepted for publication; this means that there are currently delays between acceptance and publication, and we are having to choose our articles with even greater care than usual. Please carry on submitting proposals for articles but be aware that your proposal (or article) may be rejected at the time of initial submission or after the full article is reviewed. You will have noticed that we have published little in TOG on COVID-19. The Editorial Board decided that as our journal does not have the facility to offer fast turnaround of papers, in general we would not publish articles on coronavirus on the basis that they would be out of date by the time of publication. This edition of the journal, as ever, covers topics from across our speciality. We have a Commentary from Sambit Mukhopadhyay and Mala Arora discussing how doctors in South-East Asia can benefit from the new RCOG CPD programme. I encourage everyone to read this as it has relevance for all of us, independent of where we work. There is an excellent Review that will be useful not only for members of our profession but also for general practitioners (GPs) and others caring for women’s sexual health by Ritchie et al. on the potential benefits of intrauterine contraceptive devices. They discuss use in the nulliparous population (with increased insertion failure rate but the benefits of long acting contraception). There is an excellent accompanying infographic that can be viewed on TOG online. There are two articles of interest to the obstetric readership in particular. The article by Crosby et al. on diagnosis and management of venous thromboembolism (VTE) in pregnancy will be relevant to all of us. This article will help your understanding of the best way to diagnose VTE and current management including the use (or not) of inferior vena cava filters. For the specialist – and I hope of interest to the generalist – there is an article on the investigation and management of fetal anaemia. Morris et al. have written an article that will ensure we are all able to give our women knowledge-based advice as they go through these investigations and treatments. One of the distressing aspects of cancer in young people is the potential impact on fertility for the survivors. Hartington et al. have reviewed the options for fertility preservation in pre- and postpubertal girls and boys. I recommend this article to all those who are supporting these families, including paediatric oncologists and GPs who may be inquisitive but do not know where to source this information to help their patients. Over the last few years we have published numerous articles on the pros and cons of mesh in the management of prolapse and urinary incontinence. I am grateful to Krishnaswamy et al. on their article on non-mesh surgery for urinary incontinence, bringing together the options available in 2021. It covers the ‘rediscovery’ of the techniques and benefits of colposuspension and discusses the use of autologous fascial slings. We need to consider the training (and potentially retraining) needs of our workforce and the need for collection of data to ensure long-term effects are identified as early as possible. I am, as ever, grateful to my Editorial Board for the huge amount of work they do. I am sorry that Mohamed Mehasseb is leaving us after many years of hard work supporting TOG and I am delighted to welcome Rasiah Bharathan as our newest member of the Board.

Venous Thrombotic Events Are Independently Associated with Inferior Survival Outcome in Pediatric Cancer Patients: A Multicenter Study

Background: Venous thrombotic events (VTE) are well recognized complications in pediatric oncology patients. Although risk factors for VTE have been studied the association of VTE with survival in pediatric cancer patients has not been well studied. We hypothesized that pediatric oncology patients who experienced VTE have significantly inferior survival outcome as compared to patients who did not experience VTE.Aim: To determine the association of VTE with survival outcome in pediatric oncology patients.Methods: The population studied were oncology patients from 2000-2015 in Atlantic Canada: 3 Maritime provinces (population= 1.8 million) and from the province of Newfoundland and Labrador (population= 530,000). All pediatric oncology patients from the Maritimes (Nova Scotia, New Brunswick and Prince Edward Island) are treated at the IWK Health Centre (IWK) in a shared care model with regional provincial hospitals. All pediatric oncology patients in Newfoundland and Labrador are treated at the Janeway Children's Health and Rehabilitation Centre (Janeway). This provided a population-based cohort of the total pediatric oncology patients in the 4 Atlantic provinces. Research Ethics Board approval was obtained from each institution.A database of all pediatric oncology patients treated at the IWK was created by amalgamating data from (i) Pediatric oncology hospital database (ii) Cancer in Young People in Canada registry (CYP-C) (iii) pharmacy database and (iv) hospital health records. A database of pediatric oncology patients treated at the Janeway was amalgamated from (i) Janeway written logs (ii) Hospital health records and (iii) CYP-C.Data on patient demographics, diagnosis and date of diagnosis were extracted. Status of every patient, date of last visit or date of death, on or up to December 31, 2015 was reviewed. Brain tumor patients were excluded due to the low incidence of thrombosis.The association between VTE and survival was examined using Kaplan-Meier plots and Cox Proportional Hazards regression. An exploratory survival tree analysis indicated an interaction between cancer type and VTE, and the analysis was therefore stratified by cancer type as group 1: leukemia, lymphoma, other and group 2: sarcoma. Models were adjusted for sex and age at diagnosis. The statistical analysis was performed using R version 3.3.2 and RStudio version 1.0.136.Results: Of the 943 patients included in the study, 70 were diagnosed with thrombosis (7%). The prevalence of thrombosis in group 1 and 2 was 6.9% (n=56) and 10% (n=14) respectively. Cancer types included leukemia (n=356, 38%), lymphoma (n=154, 16%), sarcoma (n=137, 15%), and other (n=296, 31%). Overall mortality was 14%. No patient died directly from VTE. Kaplan-Meier plots showed a showed inferior survival in the presence of VTE in patients in both groups 1 and 2 (Figure 1). Cox proportional hazard model showed a significantly decreased survival for patients in group 1 with a VTE (p<0.001), group 2 without a VTE (p<0.001) and group 2 with a VTE (p<0.001) as compared to patients in group 1 without VTE (Table 1). Patients with a sarcoma did not show a significant difference in patients with and without a VTE due to the overlapping confidence interval (with VTE CI: 4.53 to 20.75, without VTE CI 2.48 to 5.62). Age at diagnosis (p=0.498) and sex (p=0.300) were not associated with survival.Conclusion: In the present study, we demonstrated in a large multi-center population-based cohort of pediatric oncology patients that the survival outcome of patients with leukemia, lymphoma and other types of cancers who develop a VTE is significantly inferior as compared to that of patients who do not develop a VTE. Patients with sarcoma who developed a VTE showed a decrease in survival as compared to those who did not develop VTE. However the results were not statistically significant likely due to the small sample size of these patients. The role of possible confounders such as treatment intensity, chemotherapeutic agents, and central venous catheters were not assessed in the preset study but would be included in future research. Further larger studies are necessary to understand the association between VTE and survival outcome in pediatric oncology patients and determine the prognostic impact of VTE in them. [Display omitted] DisclosuresMoorehead:Baxalta: Honoraria, Speakers Bureau; Bayer: Honoraria; Pfizer: Speakers Bureau; Octapharma: Honoraria; Bioverativ: Honoraria.

Clinical outcomes for young patients with muscular invasive bladder cancer who received robot-assisted radical cystectomy

Objective: To evaluate the clinical features, surgical effects and factors that may affect prognosis of muscular invasive bladder cancer in young people. Methods: The clinical data of young (aged 44 and below) patients with muscle invasive bladder cancer who underwent robot-assisted radical cystectomy at the First Affiliated Hospital of Zhengzhou University from October 1st, 2014 to October 31st, 2018 were retrospectively analyzed, which included age, gender, body mass index (BMI), tumor discovery method, tumor location, tumor size, comorbid diseases, operation time, intraoperative blood loss, urinary diversion method, postoperative complications, postoperative hospital stay, postoperative pathology and follow-up results. Results: A total of 24 patients were enrolled in this study, and 18(75%) were male and 6(25%) were female. The age was (40.4±3.5) years and the BMI was (24.7±2.5) kg/m2. At initial visit, there were 19(79%) patients who presented with hematuria, 4 (17%) with lower urinary tract symptoms, and 1(4%) was discovered by routine examination. Fifteen (62%) patients had single tumor, and 9(38%) had multiple tumors. The tumor diameter of 14(58%) patients were ≥3 cm and 3(13%) patients were combined with hydronephrosis. All patients received robot-assisted radical cystectomy successfully. The operative time was (325.8±57.2) min, and the blood loss during operation was 200(162,300) ml. The duration of postoperative hospital stay was 11(9,22) days. And according to different urinary diversion methods, 17(80%) patients had ileal orthotopic neobladder and 7(20%) had ileal conduit. For patients whose sexual nerves were preserved, 6(6/9) recovered their sexual function after one year of the surgery. The final pathological results showed that 16(67%) patients were in T2 stage, 7(29%) patients were in T3 stage and that 1(4%) patient in T4 stage. There were 6 (25%) patients with lymphatic metastasis, 8(33%) with low-grade papillary urothelial carcinoma, 14(58%) with high-grade papillary urothelial carcinoma, 1(4%) with adenocarcinoma and 1(4%) with small cell neuroendocrine carcinoma. Early complications of the patients were mostly slight, and only 2(8%) patients had Clavien Ⅲdegree complications, while few patients had late complications. The follow-up time was (26±12) months. During the follow-up time, there was 1(4%) patient who died because of liver and kidney failure. Distant metastasis occurred in 4(17%) cases and 1(4%) patient had urothelial carcinoma on one side of the ureter. Lymphatic metastasis (P=0.018) and ≥ T3 (P=0.038) stage were associated with the prognosis. Conclusions: For young patients with muscular invasive bladder cancer, the major initial presentation is hematuria, and most of them have advanced tumor stage and high malignant degree. Robot-assisted radical cystectomy is a safe and effective operation method with less postoperative complications, and protecting sexual nerve contributes to the recovery of sexual function. Advanced tumor stage (≥T3) and lymphatic metastasis are associated with distant metastasis and recurrence.

"Holistic Competence": How Is it Developed, Shared, and Shaped by Health Care Professionals Caring for Adolescents and Young Adults with Cancer?

Purpose: In England, specialist cancer services for adolescents and young adults (young people) aged 15-24 are provided in 13 specialist units, with additional care provided in child and adult cancer units in the region. As a result of specialization, health care professionals (HCPs) have refined their competence, to deliver holistic care that has become central to the culture of young people's cancer care. We sought to understand and describe how HCPs developed this competence. Methods: We conducted a multiple case study in four regions across England in 24 hospitals. Data were collected through observation of clinical areas, shadowing members of the multidisciplinary team, and semistructured interviews with young people. Data were analyzed thematically and triangulated to draw meaning applicable to a range of contexts. Results: Young people (n = 29) and HCP (n = 41) across 24 different care settings were interviewed. Holistic competence enabled HCPs to deliver care that considered the age-specific needs of young people, including social, emotional, and psychological needs, in accordance with their life stage and psychosocial development. Development of holistic competence was facilitated by the following four factors: the environment, the experience continuum, enthusiasm, and education. Conclusion: The four factors facilitating holistic competence were interlinked. Working in a specialist/dedicated environment for young people increased HCPs' exposure to young people. This enabled them to become experienced in young people's cancer care, supported through education and training. Without frequent exposure to young people, HCPs were less able to achieve holistic competence, the impact of which was acutely felt by young people.

Key genes in youth colorectal cancer based on data mining and verification by reverse transcription-quantitative PCR.

In recent years, among all patients with colorectal cancer, the proportion of young patients has been gradually increasing. However, the molecular mechanisms involved in colorectal cancer in the young are largely unknown. In the present study the Gene Expression Omnibus (GEO) and The Cancer Genome Atlas datasets were integrated to elucidate the key gene biomarkers in these patients. The GSE41657 and GSE41258 datasets were downloaded from the GEO database. By screening for differentially expressed genes, Gene Ontology analysis, Kyoto Encyclopedia of Genes and Genomes pathway analysis, protein-protein interaction analysis, hub gene screening and survival analysis, two key genes, CXCL8 and VEGFA, which were enriched in cancer pathways, were obtained. Reverse transcription-quantitative (RT-q)PCR was performed to verify the outcome obtained by bioinformatics analysis. In conclusion, the present study identified two key genes using bioinformatics analysis and RT-qPCR validation. These results indicated that the candidate genes may be involved in the progression of colorectal cancer in young people, and these two genes may act as ideal prognostic indicators or therapeutic targets for colorectal cancer in the youth.

Oncofertility Approach in Females With Leukemia From the Reproductive Perspective

Leukemia is one of the most common types of cancer in young people, with 5-year survival rates ranging from 54% to 94%. Due to gonadotoxic treatment, the chances of subsequent pregnancies in leukemia survivors are generally low. To date, several methods for fertility preservation have been presented, but options for this patient group remain limited. A multidisciplinary oncofertility approach with tight coordination between hemato-oncologists and reproductive specialists is critical for maintaining a high standard of oncofertility care to increase chances for fertility preservation in females with leukemia.

P-307 Colorectal cancer in young people under 45: Experience of the medical oncology service of the Hospital Hassan II of Fez

Colorectal cancer in young people is a rare condition with a poor prognosis. Several studies have objectified the increase in its incidence as well as its aggressiveness. Family screening, genetic analysis, and early diagnosis are necessary to improve one's prognosis when risk factors exist. The aim of this work was to study the epidemiological, anatomical-clinical, therapeutic and progressive characteristics in order to assess the factors of poor prognosis in this young population. We performed a retrospective study including 40 cases aged less than 45 years with colorectal cancers diagnosed and managed within the medical oncology department of the Hassan II teaching hospital in Fez, between January 2013 and June 2017. 40 cases were included which represented 22% of all colorectal cancers during the study period. Average age was 33 years (range 19 and 45). The sex ratio was 1.7 with a clear male predominance. Colorectal cancer-predisposing history was present in 11% of patients. The tumor was located in the right colon in 37.5% of cases and in the rectum in 32.5% of cases. Over 18% of cases were discovered during a complication (13.6% during an occlusion and 5.5% continued perforation). 13% of patients had mucous (mucinous) colloid carcinoma. The cancers were poorly differentiated in 35% of the cases. Existence of vascular emboli and nerve sheaths were found in only 22 files; the presence of emboli was noted in 37.5% of cases. 41% of patients were stage III or stage II with MSS status and poor prognosis factors and received a adjuvant chemotherapy following surgical treatment. 4% of patients were stage II with MSI status, without risk factors and received no adjuvant therapy. 55% of patients were metastatic from the start and received basic chemotherapy (fluoropyrimidine). Radiation therapy was performed in 26% of patients with cancer of the middle or lower rectum. The median survival time, all stages included, was 16 months (1-60 months). According to these results, colorectal cancer in young people has a poor prognosis, mainly due to the advanced disease stage at the time of diagnosis, as well as the frequent occurrence of recurrences in the case of undifferentiated tumors. Multidisciplinary care and genetic analysis seem essential to improve the prognosis of these patients.

Use of Tissue Plasminogen Activator as a Surrogate Measure for Central Venous Catheter Dysfunction and Survival Outcome in Children with Cancer: A Population-Based Retrospective Cohort Study

Central venous catheter (CVC) dysfunction is often associated with thrombosis, which in turn has been linked with poorer survival outcomes in cancer patients. Our objective was to examine the association of tissue plasminogen activator (tPA) administration as a surrogate measure of CVC dysfunction with survival in pediatric cancer patients. The present study uses data from a population-based retrospective cohort of pediatric oncology patients from the Canadian Maritime provinces treated between 2000 and 2017 at the IWK Health Centre, Halifax, NS. Demographics, diagnosis, date of death or date of last visit, and tPA use for CVC dysfunction were obtained from clinical databases and the provincial Cancer in Young People in Canada registry. The association between tPA administration and survival was examined using a Cox regression model adjusted for sex, age at diagnosis, cancer type, thrombosis, CVC duration, diagnosis era, and treatment modalities. Out of 821 patients, 206 received one or more doses of tPA during upfront therapy. The death rate was 21% and 15% respectively in patients who did and did not receive tPA. In the adjusted regression model, after receiving one or more doses of tPA, children had significantly poorer survival as compared to those that did not receive tPA (HR: 1.496, 95% CI: 1.019, 2.197). CVC dysfunction may be associated with a poorer prognosis in pediatric cancer patients. Future studies should corroborate these findings in other populations, examine the influence of other potential confounders, and determine the role of CVC dysfunction in prognostic models of cancer survival.

Regional differences in access to hematopoietic stem cell transplantation among pediatric patients with acute myeloid leukemia.

Indications for hematopoietic stem cell transplantation (HSCT) in pediatric acute myeloid leukemia (AML) are primarily dependent on risk stratification at diagnosis and relapse status. We sought to determine whether access to HSCT is influenced by regional and socioeconomic factors. Children with newly diagnosed AML aged<15 years between 2001 and 2015 were identified using the Cancer in Young People in Canada national population-based registry. Factors potentially associated with the receipt of HSCT were studied using univariate and multivariable logistic regression models. Overall, 568 children with newly diagnosed AML were included and 262 (46%) received HSCT. A greater proportion of patients, 103/157 (65.6%), underwent HSCT after first or subsequent relapse compared to 159/411 (38.7%) patients who underwent transplant before relapse. Among patients for whom HSCT would be considered before relapse, factors associated with higher odds of HSCT in a multivariable analysis were: poor versus good-risk cytogenetics (Odds ratio [OR]: 30.0, 95% confidence interval [CI]: 7.7-117.0), diagnosis during 2012-2015versus 2001-2006 (OR: 3.2, 95% CI: 1.6-6.3), diagnosis in eastern Canada versus central Canada (OR: 3.7, 95% CI: 1.9-7.3), and age 10-14 years versus age<1 year (OR: 5.4, 95% CI: 2.3-12.8). Among patients for whom HSCT would be considered after first relapse, higher odds of HSCT was associated with diagnosis at a HSCT center (OR: 2.1, 95% CI: 1.1-4.1). Patients diagnosed at a HSCT performing center and patients from eastern Canada had higher odds of receiving HSCT. This may suggest preferential access to HSCT for certain patients.

Incidence trends in pediatric central nervous system tumors in Canada: a 15 years report from Cancer and Young People in Canada (CYP-C) registry.

BackgroundThe aim of this study is to present a national surveillance report on pediatric central nervous system (CNS) tumors in Canada during the period between 2001 and 2015.MethodsAll pediatric patients with a diagnosis of primary CNS tumors were collected by the Cancer in Young People in Canada (CYP-C) surveillance system that includes every patient less than 15 years of age with a tumor seen in one of the 17 pediatric oncology centres in Canada. This registry included malignant and benign CNS tumors. We calculated the age-adjusted incidence rates (AAIRs) per 100 000 person-years for CNS tumors overall and by age group, major histology subgroups, and geographical distribution over the country.ResultsOverall, 3306 patients less than 15 years old had been diagnosed with a CNS tumor in Canada in 2001–2015 with a 1.23:1 male to female ratio. The overall AAIR is 3.80. The three most frequent groups of tumors were low-grade gliomas (36.4%), high-grade gliomas (22.3%), and embryonal tumors (18.7%) with incidence rates of 1.41, 0.86, and 0.72 per 100 000 person-years, respectively. The incidence rate of pediatric CNS tumors is stable during the period 2001–2015 in Canada and no significant differences were seen between malignant and benign tumors over the country.ConclusionsThese data represent all the pediatric patients 0–14 years old with a CNS tumor in the Canadian population. Incidence rates by age group, sex, and subgroups of tumors are similar to those seen in the literature.

Breast cancer in a 23-year-old nursing mother – case report

Introduction: Breast cancer is uncommon in women below 35 years of age, and the diagnosis can be delayed due to higher breast density and less attention during clinical examination. Survival in young women is worse than in individuals from an older age group, and treatment may have a greater physical and psychological impact on these patients. This relevant report describes the clinical case of a 23-year-old nursing mother, non-smoker, and without a family history of cancer, who detected a nodule in the left breast during self-examination. She sought medical care after three months due to nodule increase and local pain, which was treated as mastitis. Without improvement, she visited the mastology department, which identified, during clinical examination, a 9 cm, mobile, ill-defined nodule, and negative axillary nodes. Breast ultrasound found two spiculated, heterogeneous nodules, with ill-defined borders in the left upper outer quadrant. Core biopsy revealed an invasive breast carcinoma with luminal B immunophenotype. The patient underwent neoadjuvant chemotherapy with good response, lumpectomy, and sentinel lymph node biopsy. She has been receiving chemotherapy for subsequent radiotherapy and hormone therapy. Objectives: Since currently breast cancer has no proven preventive measure, this work aims at highlighting the importance of raising awareness about the possibility of cancer among young patients for early diagnosis and prompt treatment so as to increase the survival of diagnosed patients. Discussion: Breast cancer is the main death-related neoplasm in the Brazilian female population, representing a challenge for public health. The main risk factors are family history, advanced age, and reproductive characteristics. Studies show that the most common histological type in young individuals is invasive ductal and that this age group has peculiarities concerning risk factors, tumor biology, genetics, prognosis, and social and psychological impact. Classic symptoms, such as breast and axillary nodules and changes in the breast and nipple skin, indicate the need to seek medical help. Treatment is not distinct from that of older age groups, but the diagnostic difficulty warns about the importance of paying attention to any suspicious sign of this disease. Regarding prevalence, breast cancer in young people is rarer than in older individuals, but recurrence is higher. Clinical suspicion can be hindered by the greater breast density and the lack of disease screening among these patients. Conclusion: Early clinical suspicion based on detailed medical history and physical examination contributes to effective diagnosis and therapeutic approach, seeking a better quality of life and higher patient survival.

LASER THERAPY AS ADJUNCTIVE TREATMENT FOR ORAL MUCOSITIS IN A PEDIATRIC PATIENT WITH NON-HODGKIN LYMPHOMA

Lymphomas represent the third most common type of cancer in young people, classified into non-Hodgkin (NHL) or Hodgkin lymphoma. NHL arises when B or T cells, which are involved in the protection, become malignant, growing uncontrollably, "contaminating" the lymphatic system. Characterized by a high degree of malignancy with pathology and immunology of different characteristics. Radiotherapy or chemotherapy are treatments performed for this disease, which may lead to oral manifestations because of its cytotoxicity. A 13-year-old male patient diagnosed as having NHL presented during treatment white pseudomembrane and erythematous ulcers, painful to the touch in regions of the buccal mucosa and bilateral border of the tongue, suggestive of mucositis. As a therapeutic option, we performed photodynamic and low-level laser therapy in association with pharmacologic and local hygiene because of immunosuppression, obtaining remission of the lesions after 7 days. Laser therapy is a noninvasive, adjuvant tool that promotes analgesic, anti-inflammatory and biostimulating effects. Lymphomas represent the third most common type of cancer in young people, classified into non-Hodgkin (NHL) or Hodgkin lymphoma. NHL arises when B or T cells, which are involved in the protection, become malignant, growing uncontrollably, "contaminating" the lymphatic system. Characterized by a high degree of malignancy with pathology and immunology of different characteristics. Radiotherapy or chemotherapy are treatments performed for this disease, which may lead to oral manifestations because of its cytotoxicity. A 13-year-old male patient diagnosed as having NHL presented during treatment white pseudomembrane and erythematous ulcers, painful to the touch in regions of the buccal mucosa and bilateral border of the tongue, suggestive of mucositis. As a therapeutic option, we performed photodynamic and low-level laser therapy in association with pharmacologic and local hygiene because of immunosuppression, obtaining remission of the lesions after 7 days. Laser therapy is a noninvasive, adjuvant tool that promotes analgesic, anti-inflammatory and biostimulating effects.

The culture of young people's cancer care: A narrative review and synthesis of the UK literature.

Growing consensus describes it as "inappropriate" to deliver care to young people in either child or adult environments of care or in settings not equipped to meet their psychosocial needs. The aim of this review was to identify what patient and professional experience tells us about the culture of care specific to young people receiving cancer care in the UK. A narrative review of published, UK-based research was conducted. Five online databases were searched using terms related to "culture of care," "cancer" and "adolescent." Papers were assessed for relevance, according to pre-determined criteria: 19/1,366 identified papers met our inclusion criteria. Studies included in this review were predominantly reflective of care received in specialist units. The findings were in support of "young people-friendly," "tailored environments," showing how they facilitate young people to have positive experiences of care. Communication, information delivery and patient choice were themes that were central to the culture of care. Highlighted was the need to provide care beyond addressing clinical needs through a young person-centred approach, to facilitate optimal experiences of care. However, to fully understand the culture of care, research needs to focus on the delivery of care outside of specialist units.